Limitations and Strengths of Doppler/Echo Pulmonary Artery Systolic Pressure-Right Heart Catheterization Correlations: A Systematic Literature Review

2014 ◽  
Vol 32 (1) ◽  
pp. 10-18 ◽  
Author(s):  
Robert S. Finkelhor ◽  
Steven A. Lewis ◽  
Dilip Pillai
Keyword(s):  
Literature Review ◽  
Pulmonary Artery ◽  
Systematic Literature Review ◽  
Systolic Pressure ◽  
Right Heart Catheterization ◽  
Pulmonary Artery Systolic Pressure ◽  
Heart Catheterization ◽  
Right Heart

scholarly journals Preoperative Evaluation of Pulmonary Hypertension in Lung Transplant Candidates: Echocardiography Versus Right Heart Catheterization

2021 ◽  
Author(s):  
Tal Abu ◽  
Amos Levi ◽  
David Hasdai ◽  
Mordechai R. Kramer ◽  
Tamir Bental ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Preoperative Evaluation ◽  
Systolic Pressure ◽  
Area Under The Curve ◽  
Right Heart Catheterization ◽  
Mean Value ◽  
Pulmonary Artery Systolic Pressure ◽  
Heart Catheterization ◽  
Right Heart

Abstract Background - Right heart catheterization (RHC) and echocardiography are both routinely used for pulmonary artery systolic pressure (PASP) assessment in lung transplantation (LT) candidates, although this is not mandated by current guidelines. We aimed to explore the correlation between PASP estimated by echocardiography to that measured by RHC, in this population in order to assess the necessity of RHC. Methods - From a retrospective registry of 393 LT candidates undergoing RHC and echocardiography during 2015-2019, patients were assessed for the presence of pulmonary hypertension (PH), defined as mean pulmonary artery pressure (mPAP) above 20 mmHg, according to two methods – echocardiography and RHC. The primary outcome was the correlation between the PASP estimated by echocardiography to that measured by RHC. Secondary outcomes were the prediction value of the echocardiographic evaluation and its accuracy. Results - The mean value of PASP estimated by echocardiography was 49.5±20.0 mmHg, compared to 42.5±18.0 mmHg measured by RHC. The correlation between the two measurements was moderate (Pearson’s correlation: r=0.609, p<0.01). Echocardiography PASP measurements were moderately discriminative to diagnose PH, with an area under the curve (AUC) of 0.72 (95% CI 0.66-0.76). Echocardiographic overestimation of PASP of more than 10 mmHg was found in 35.0% of the patients, and underestimation was found in 11.6% of the patients.Conclusion - In the pre-surgical evaluation of LT candidates, echocardiographic estimation of PASP had moderate correlation and limited accuracy compared to the PASP measured by RHC. We thus recommend performing routine RHC to all LT candidates, regardless of the echocardiographic estimation of PASP.

scholarly journals Assessment of pulmonary artery hypertension by Doppler echocardiography and its correlation with right heart catheterization

2021 ◽  
Vol 8 (4) ◽  
pp. 523
Author(s):  
Vikrant B. Khese ◽  
Chandrakant B. Chavan ◽  
Ravi Kalra ◽  
Anirudh K. Allam ◽  
Abhinav Mohabey
Keyword(s):  
Pulmonary Artery ◽  
Systolic Pressure ◽  
Maximum Velocity ◽  
Right Heart Catheterization ◽  
Pulmonary Artery Hypertension ◽  
Pulmonary Artery Systolic Pressure ◽  
Heart Catheterization ◽  
Right Heart ◽  
Number Of Patients ◽  
Pulmonary Arterial

Background: Definitive diagnosis of pulmonary artery hypertension (PH) requires an elevated mean pulmonary arterial pressure (MPAP) of 25 mmHg at rest measured by right heart catheterization (RHC). As it is invasive mode of investigation, it is declined by many patients, echocardiography was thought to be an acceptable substitute to assess pulmonary arterial pressures. Whether there is a correlation between these measurements is controversial. The aim of this study was to assess PH by echocardiography and its correlation with RHC.Methods: Twenty-six patients aged ≥18 years with pulmonary artery hypertension with or without tricuspid regurgitation (TR) were included in this cross-sectional study. All the patients underwent a transthoracic echocardiography evaluation and were taken for RHC study within an hour.Results: The correlation between pulmonary artery acceleration time (PAAT) and pulmonary artery systolic pressure (PASP) and PAAT and MPAP was significant in all degrees of PH. In contrast, correlation between TR jet maximum velocity (TR Vmax) derived estimated pulmonary artery systolic pressure (EPASP) and PASP was significant in moderate and severe PH, while it did not correlate in mild PH.Conclusions: PAAT is easily measurable parameter and strongly correlates with the values of PASP and the MPAP obtained by right heart catheterization. Implementation of a novel method of determining EPASP from PAAT shall increase significantly the number of patients in whom TTE can be used for the assessment of pulmonary hemodynamic non-invasively.

scholarly journals Accuracy and Influencing factors of Pulmonary Artery Systolic Pressure estimated by Doppler Echocardiography: Comparsion with Right Heart Catheterization

2021 ◽  
Author(s):  
Guangjie Lv ◽  
Aili Li ◽  
Xincao Tao ◽  
Yanan Zhai ◽  
Yu Zhang ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Pulmonary Artery ◽  
Influencing Factors ◽  
Systolic Pressure ◽  
Right Heart Catheterization ◽  
Pulmonary Artery Systolic Pressure ◽  
Heart Catheterization ◽  
Signal Quality ◽  
Limits Of Agreement ◽  
Right Heart

Abstract Purpose This study aimed to explore the accuracy and influencing factors of noninvasive assessment of pulmonary artery systolic pressure by Doppler echocardiography (sPAPECHO) with right heart catheterization (RHC) as reference. Methods A total of 218 highly suspected pulmonary hypertension (PH) patients who underwent RHC and echocardiography within 7 days were included. The ratio of (sPAPECHO-sPAPRHC)/sPAPRHC was calculated and divided into three groups, namely, the underestimation group, accurate group and overestimation group by ± 10% as the boundary. The correlation and consistency between tricuspid regurgitation (TR) derived parameters and RHC results were tested by Pearson and Bland-Altaman methods. With mPAP ≥ 25mmHg measured by RHC as the standard diagnostic criteria of PH, ROC curve was used to evaluate the diagnostic efficacy. The influencing factors of sPAPECHO were analyzed by ordered regression analysis. Results sPAPECHO had the greatest correlation coefficient (r = 0.781, P < 0.001) and best diagnostic efficiency (AUC = 0.98) compared with other TR related methods. Bland-Altman analysis demonstrated the bias of sPAPECHO (mean bias = 0.07mmHg, 95% limits of agreement: -32.08 to + 32.22mmHg) was lower than that of TR-PG (mean bias = 5.87mmHg, 95% limits of agreement: -26.46 to + 38.21mmHg). The results of ordered regression analysis showed that TR signal quality, PAWP and sPAPRHC level affected the accuracy of sPAPECHO (P < 0.05). Relative to the signal quality of type A, the OR value of type B and C signal quality were 0.26 (95%CI: 0.14, 0.48) and 0.23 (95%CI: 0.07, 0.73), respectively. The OR value of PAWP was 0.94 (95%CI: 0.89, 0.99). Compared with high sPAPRHC level, the OR value of low and medium sPAPRHC level were 21.56 (95%CI: 9.57, 48.55) and 5.13 (95%CI: 2.55, 10.32), respectively. Conclusion sPAPECHO was superior than other TR-related methods in screening PH. TR signal quality is vital for accurate assessment of sPAPECHO. For patients with pre-capillary disease, a higher echocardiographic threshold is more suitable for determining the possibility of PH, especially during the initial stage of disease.

Abstract 17391: Use of Contrast-Enhanced Echocardiography for Evaluating Pulmonary Artery Pressure

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Lauren Lee ◽  
Menhel Kinno ◽  
Robert Schultz ◽  
Bonnie Kane ◽  
Gregory Cascino ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Correlation Coefficient ◽  
Vena Cava ◽  
Systolic Pressure ◽  
Right Heart Catheterization ◽  
Mean Difference ◽  
Pulmonary Artery Systolic Pressure ◽  
Heart Catheterization ◽  
Number Of Patients ◽  
Contrast Enhanced Echocardiography

Introduction: Pulmonary artery systolic pressure (PASP) can be derived from maximum tricuspid regurgitation velocity (TRV) obtained from echo using a modified Bernoulli equation. However, PASP from an unenhanced echo only modestly correlates to invasively measured PASP. This study evaluates whether the accuracy of PASP from an echo can be improved by using contrast agents. Methods: Ninety consecutive patients undergoing clinically indicated right heart catheterization were recruited to perform simultaneous echo. TRV was measured in an echo unenhanced (UE), with agitated saline (AgS), and with echo contrast (EC) (routinely injected centrally, and peripherally in 21 patients). PASP was then calculated using the formula PASP=4(TRV 2 )+RAP, where RAP was estimated on echo by inferior vena cava collapsibility. Data was analyzed using paired t-test and linear regression (JMP Pro13). Results: Average age was 54 (±13) years with 58% males, 73% heart transplant recipients, and 38% with pulmonary hypertension. UE PASP was significantly lower than RHC PASP with a mean difference of -6.09 mm Hg (p<0.001) and correlation coefficient of 0.57 (p<0.001). In comparison, AgS PASP had a smaller mean difference of 0.41 mm Hg (p=0.641) and a higher correlation coefficient of 0.73 (p<0.001). EC-enhanced echo also yielded a smaller mean difference (central: -1.82 mm Hg with p=0.049; peripheral: -3.21 mm Hg with p=0.095) and an even higher correlation coefficient (central: r=0.74; peripheral: r=0.81). Number of patients with accurate PASP from echo (defined as PASP difference <10 mm Hg between echo and RHC) was improved from 65% (UE) to 77% (AgS), 82% (EC-central), and 71% (EC-peripheral). Conclusion: Echo with agitated saline yielded the closest mean PASP compared to invasivePASP, whereas echo with peripherally administered EC yielded the highest correlation coefficient. Echo enhancement with either Ags or EC can improve the accuracy of the estimated PASP compared to UE studies.

scholarly journals What is the role of screening for pulmonary hypertension in adults and children with sickle cell disease?

Hematology ◽  
2017 ◽  
Vol 2017 (1) ◽  
pp. 431-434 ◽  
Author(s):  
Shaina M. Willen ◽  
Mark T. Gladwin
Keyword(s):  
Pulmonary Artery ◽  
Diastolic Pressure ◽  
Systolic Pressure ◽  
High Plasma ◽  
Right Heart Catheterization ◽  
Pulmonary Artery Systolic Pressure ◽  
Heart Catheterization ◽  
Indirect Bilirubin ◽  
Pain Medications ◽  
Echocardiographic Study

Abstract Patient case: An 18-year-old male patient with homozygous hemoglobin SS disease was evaluated for progressive dyspnea and elevated tricuspid regurgitant jet velocity (TRV) on echocardiography. The patient’s case is described in detail in Lancet.1 He had been treated with regular transfusions since childhood for stroke, had rare episodes of vaso-occlusive pain episodes, and did not take narcotic pain medications. He presented with progressive severe dyspnea on exertion and lower extremity edema. His laboratory tests were notable for a total hemoglobin level of 11.8 g/dL and hemoglobin S levels <30% but with 18% reticulocytes and elevated markers of hemolysis, such as high plasma levels of lactate dehydrogenase, aspartate amino transferase, and indirect bilirubin. The computed tomography scan of his chest in Figure 1A-B shows a large pulmonary artery, which has a greater diameter than his aorta, and a mosaic perfusion pattern, typical for severe pulmonary arterial hypertension. His Doppler echocardiographic study (Figure 1C) showed an unusually high TRV of 5.93 m/s, consistent with a calculated pulmonary artery systolic pressure of >140 mm Hg (4 times the TRV squared = 4V2). Additional images in Figure 1D show a dilated right ventricle and right atrium with a compressed left ventricle. The patient’s right heart catheterization revealed a pulmonary artery systolic pressure of 147 mm Hg and diastolic pressure of 49 mm Hg; note that the normal values are ∼25/10 mm Hg.

scholarly journals Preoperative evaluation of pulmonary hypertension in lung transplant candidates: echocardiography versus right heart catheterization

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
K Skalsky ◽  
T Abu ◽  
A Levi ◽  
T Bental ◽  
R Hirsh ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Preoperative Evaluation ◽  
Systolic Pressure ◽  
Right Heart Catheterization ◽  
Mean Value ◽  
Secondary Outcome ◽  
Pulmonary Artery Systolic Pressure ◽  
Chronic Obstructive ◽  
Heart Catheterization ◽  
Right Heart

Abstract Background Right heart catheterization (RHC) and echocardiography are both routinely used for pulmonary hypertension (PH) assessment in LT candidates, although this is not mandatory according to guidelines. We aim to describe the correlation between the pulmonary artery systolic pressure (PASP) measured by echocardiography to that measured by RHC in this population. Methods From a retrospective registry of 461 LT candidates, undergoing RHC between 2015–2019, 393 consecutive patients were assessed for the presence of pulmonary hypertension according to two methods – echocardiography and RHC. The primary outcome was the correlation between the estimated PASP measured by echocardiography to that measured by RHC. Secondary outcome was the accuracy of the echocardiographic assessment of PH. Results Patients were predominantly males (63.6%) with a mean age of 61.46±8.33y. The two most common etiologies for lung failure were interstitial lung disease or pulmonary fibrosis (52.2%) and chronic obstructive pulmonary disease (30.5%). Estimated PASP as measured by echocardiography was available in 89.31% of the patients, with a mean value of 49.5±20.02 mmHg. Mean PASP measured by RHC was 42.47±17.96 mmHg. The correlation between the two measurements was moderate (Pearson's correlation: r=0.609, p&lt;0.01). The accuracy of the echocardiographic estimation of PASP was poor with &gt;10 mmHg differences between the two values in 79.9% of the patients. Conclusions In the pre-surgical evaluation of LT candidates, echocardiographic estimation of PASP has moderate correlation with the PASP measured by RHC and relatively poor accuracy. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals The Accuracy and Influencing Factors of Doppler Echocardiography in Estimating Pulmonary Artery Systolic Pressure: Comparison With Right Heart Catheterization : A Retrospective Cross-sectional Study

2021 ◽  
Author(s):  
Guangjie Lv ◽  
Aili Li ◽  
Xincao Tao ◽  
Yanan Zhai ◽  
Yu Zhang ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Regression Analysis ◽  
Influencing Factors ◽  
Systolic Pressure ◽  
Right Heart Catheterization ◽  
Pulmonary Artery Systolic Pressure ◽  
Heart Catheterization ◽  
Signal Quality ◽  
Right Heart ◽  
Ordinal Regression Analysis

Abstract Background: Noninvasive assessment of pulmonary artery systolic pressure by Doppler echocardiography (sPAPECHO) has been widely adopted to screen for pulmonary hypertension (PH). But high proportion of overestimation or underestimation of sPAPECHO still remained. So we aimed to explore the accuracy and influencing factors of sPAPECHO with right heart catheterization (RHC) as reference. Methods: A total of 218 highly suspected pulmonary hypertension (PH) patients who underwent RHC and echocardiography within 7 days were included. The correlation and consistency between tricuspid regurgitation (TR) derived parameters and RHC results were tested by Pearson and Bland-Altaman methods. With mPAP ≥25mmHg measured by RHC as the standard diagnostic criteria of PH, ROC curve was used to compared the diagnostic efficacy of sPAPECHO with other TR related methods. The ratio of (sPAPECHO-sPAPRHC)/sPAPRHC was calculated and divided into three groups, namely, the underestimation group, accurate group and overestimation group by ±10% as the boundary. The influencing factors of sPAPECHO were analyzed by ordinal regression analysis.Results: sPAPECHO had the greatest correlation coefficient (r=0.781, P<0.001), best diagnostic efficiency (AUC=0.98) and lowest bias (mean bias= 0.07mmHg, 95% limits of agreement: -32.08 to +32.22mmHg) compared with other TR related methods. Ordinal regression analysis showed that TR signal quality, PAWP and sPAPRHC level affected the accuracy of sPAPECHO (P < 0.05). The OR value of PAWP was 0.94 (95%CI: 0.89, 0.99). Compared with high sPAPRHC level, the OR value of low and medium sPAPRHC level were 21.56 (95%CI: 9.57, 48.55) and 5.13 (95%CI: 2.55, 10.32) , respectively. Relative to the signal quality of type A, the OR value of type B and C signal quality were 0.26 (95%CI: 0.14, 0.48) and 0.23 (95%CI: 0.07, 0.73), respectively. While TR severity and right ventricular systolic function had no significant effect on the accuracy of sPAPECHO. Conclusions: sPAPECHO was superior to other TR-related methods in PH screening, and was often overestimated in patients with pre-capillary PH at low sPAPRHC level, even with good TR signal quality.Trial registration: This is a retrospectively registered study.

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